Did You Look And Feel? Hands and eyes on?

[spenac]

On a couple of other topics I was just surprised at how hands and eyes off people are in treating their patients. I was taught in all 4 levels of EMS school I have taken or taking that to do a good exam requires all our senses except taste, and sometimes taste comes into play as odor is so strong you taste it. What do you see, feel, smell, hear? I was taught that if a person complains of something say stomach pain you expose and see if anything visible, then you palpate starting on the areas w/o pain moving to the painful area, finally you auscultate the area. During this you may note various odors. Even in clinicals a the hospital I was asked to do all the above and even had Docs bring to my attention some of what I was feeling or hearing.

So my question is am I the only one taught this way? While it may not affect our immediate care of the patient do you feel it is still part of a proper EMS exam? What are your thoughts?

[firedoc5]

Fortunately I had outstanding instructors in classes that I took, and instructors I taught along side with that emphasized just this matter. I've been taught to use all your senses, not just with the patient but also with the entire surroundings. One way I put it is that you pay attention to every detail but don't get distracted by any one element.

I'm glad you brought this up, spenac.

[itku2er]

That is how I was taught is to keep all your senses on alert. Cause you never know when there may be an unforseen problem might be lurking in the background. I think that some times people take for granted scene safty and are too relaxed for unseen things. Patient assessment is no different hands on is the best.

ITK

[AnthonyM83]

That's one of the things I've learned here...I forget at times b/c I have to self-teach and didn't turn it into a habit during EMT school. But some of the medics around here obviously didn't learn it either....I've been handed of patients that were never touched once...even to get vitals. I guess when you become a medic here, you get the jedi skill of just 'sensing' vital signs....i can only wait...

[itku2er]

I do too anthony I dont rely on the machines manual bps manual pulses even put my hand on the chest when I do resperations.

[JakeEMTP]

Good topic.

I have to add a recent experience. I was assisting with the Basic class during their patient assessment skills. A common theme which had to continuously be stressed by myself and some of the others was the fact that, " You know, you actually have to touch the patient" :?.

While enjoying a meal and a few cocktails after we were discussing this. Perhaps they were just afraid to touch each other or were they just nervous because we were there.? I don't know the answer, but I hope they figure it out before they get on the ambulance.

I was taught to palpate, auscultate and visualise. How else can you function in the profession?

Oh, and add LA to the list of places not to visit.

[spenac]

To drive home the need at times to be hands on during FR class I was checking lung sounds on an older rather large breasted instructor. To avoid touching I went lower than normal for lung sounds. She grabbed my hand and using the back of my hand said lift, now listen where you are supposed to. She then explained you can ask women to lift or you may have to do it but you never do an improper evaluation. That one change might be how something vital is missed.

Point is if you are afraid to touch, to look, to listen maybe this is the wrong field for you.

Do you listen to lung and heart sounds thru the patients shirt or do you get to the skin?

[itku2er]

skin

[JakeEMTP]

Do you listen to lung and heart sounds thru the patients shirt or do you get to the skin?

I always expose the chest during my assessment in the ambulance, depending on the nature of the call. A leg injury does not alway require listening to lung sounds. I do however go under their clothing to listen while on scene. Simply by undoing a few buttons or untucking a t-shirt allows you access to the bare chest without compromising your patients privacy.

[spenac]

skin

Thank you. so many new people and even supposedly experienced people listen thru clothes, even heavy sweaters. This muffling could cause you to miss a click or perhaps decide that sounds are diminished, or maybe you miss the popping.

If you are going to do this job do it right.